ABSTRACT Research Objectives. The project addresses a Tier 1 CDC Research Priority Area C in Traffic Injury, as well as NCIPC Research Objectives 4 (research the cost and cost-effectiveness of policies to prevent transportation injuries to children) and 7 (research that can inform policy debates on the most effective way to reduce childhood injuries, eg. small experimental studies, cost-effectiveness analyses of promising interventions). Importance. Learning to drive, often considered warmly as a "rite of passage," is also the riskiest activity undertaken during adolescence. Young drivers are practiced users of cell phone and text messaging services ("voice/text devices"), and increasingly use them when driving. Cohort studies suggest that the use of voice/text devices is associated with crash risks ranging from 4 to 24 times over baseline levels. Objectives. Conduct a pilot intervention study among new teen drivers comparing a) event-triggered monitoring, b) electronic transmission blocking, and c) a control group to examine the cost-effectiveness in reducing voice/text device use. We propose three specific aims: (i) Identify factors promoting the enrollment and retention of enrolling of teen participants. (ii) Derive comparative effectiveness and cost estimates for each intervention on a) voice/text device use while driving;and b) high-risk driving events as measured by an event-triggered accelerometer. (iii) Conduct focus groups with teens and parents to learn about the acceptability of interventions, and investigate whether teens are able to subvert the proposed intervention. We hypothesize that the intervention conditions will reduce high risk driving events for new adolescent drivers, will limit telephone and text messaging during driving, and may be cost-effective relative to other accepted interventions. Study design. Randomized controlled trial. Setting/participants. Community-based study of 60 male and female new teen drivers (within 1 month of obtaining license) in an urban setting. Drivers will be recruited from departments of licensing and driver education schools, and will be followed for six months. Intervention. Sixty new drivers will be randomized to 1 of 3 intervention conditions. All vehicles will have an installed event-triggered monitoring device to measure risky driving and record in-vehicle distractions. The monitors also serve to collect important outcome data on driving risk and the use of voice/text devices, as well as exposure to driving conditions. Only group 1 participants will get immediate and family feedback on risky driving events during the study period. Group 1: Event-triggered monitoring and feedback. The monitoring and feedback system works by installing an on-board camera in the vehicle, triggered by an accelerometer. When a sudden stop or swerve triggers the in-vehicle accelerometer, the in-vehicle camera is briefly activated, and red light tells the driver the event has been recorded. Weekly video feedback and scoring is sent to parents and teens, where high risk driving behaviors and telephone/text use, can be jointly reviewed and discussed. Group 2: Electronic transmission technologies work using GPS-activated cellular phones. The GPS system identifies when the phone is travelling at a velocity exceeding 10mph, and blocks incoming calls/messages as well as outgoing calls/messages. It sends a message to the caller, notifying them that the driver is occupied and will return the call when able. Group 3: Control. Teens in this group will receive a pamphlet describing driving risks and a review of state graduated driving laws. At the conclusion of the study, all teens and parents have the option of receiving information on the teen's driving performance and risk scores. Outcome measures. At the conclusion of this pilot project, we will have critical information on feasibility and risk estimates needed to undertake a definitive intervention study to reduce distracted driving due to voice/text devices. Specific measures include (i) risky driving events measured by event-triggered in-vehicle camera;(ii) use of voice/text devices while driving;(iii) cost measures;(iv) qualitative findings from focus group interviews. Impact. These data will motivate a larger study of innovative approaches to combat distracted driving. PUBLIC HEALTH RELEVANCE: Narrative Young drivers are practiced users of cell phone and text messaging services, yet cohort studies suggest that the their use is associated with crash risks ranging from 4 to 24 times over baseline levels. We propose to conduct a pilot intervention study among new teen drivers comparing a) event-triggered monitoring, b) electronic transmission blocking, and c) a control group to examine the cost-effectiveness in reducing voice/text device use. We hypothesize that the intervention conditions will reduce high risk driving events for new adolescent drivers, will limit telephone and text messaging during driving, and may be cost-effective relative to other accepted interventions.